Toward Systems Models for Obesity Prevention: A Big Role for Big Data.

The relation among the various causal factors of obesity is not well understood, and there remains a lack of viable data to advance integrated, systems models of its etiology. The collection of big data has begun to allow the exploration of causal associations between behavior, built environment, and obesity-relevant health outcomes. Here, the traditional epidemiologic and emerging big data approaches used in obesity research are compared, describing the research questions, needs, and outcomes of 3 broad research domains: eating behavior, social food environments, and the built environment. Taking tangible steps at the intersection of these domains, the recent European Union project "BigO: Big data against childhood obesity" used a mobile health tool to link objective measurements of health, physical activity, and the built environment. BigO provided learning on the limitations of big data, such as privacy concerns, study sampling, and the balancing of epidemiologic domain expertise with the required technical expertise. Adopting big data approaches will facilitate the exploitation of data concerning obesity-relevant behaviors of a greater variety, which are also processed at speed, facilitated by mobile-based data collection and monitoring systems, citizen science, and artificial intelligence. These approaches will allow the field to expand from causal inference to more complex, systems-level predictive models, stimulating ambitious and effective policy interventions.

Intake monitoring in free-living conditions: Overview and lessons we have learned.

The progress in artificial intelligence and machine learning algorithms over the past decade has enabled the development of new methods for the objective measurement of eating, including both the measurement of eating episodes as well as the measurement of in-meal eating behavior. These allow the study of eating behavior outside the laboratory in free-living conditions, without the need for video recordings and laborious manual annotations. In this paper, we present a high-level overview of our recent work on intake monitoring using a smartwatch, as well as methods using an in-ear microphone. We also present evaluation results of these methods in challenging, real-world datasets. Furthermore, we discuss use-cases of such intake monitoring tools for advancing research in eating behavior, for improving dietary monitoring, as well as for developing evidence-based health policies. Our goal is to inform researchers and users of intake monitoring methods regarding (i) the development of new methods based on commercially available devices, (ii) what to expect in terms of effectiveness, and (iii) how these methods can be used in research as well as in practical applications.

Exploring Associations Between Children's Obesogenic Behaviors and the Local Environment Using Big Data: Development and Evaluation of the Obesity Prevention Dashboard.

BACKGROUND: Obesity is a major public health problem globally and in Europe. The prevalence of childhood obesity is also soaring. Several parameters of the living environment are contributing to this increase, such as the density of fast food retailers, and thus, preventive health policies against childhood obesity must focus on the environment to which children are exposed. Currently, there are no systems in place to objectively measure the effect of living environment parameters on obesogenic behaviors and obesity. The H2020 project "BigO: Big Data Against Childhood Obesity" aims to tackle childhood obesity by creating new sources of evidence based on big data. OBJECTIVE: This paper introduces the Obesity Prevention dashboard (OPdashboard), implemented in the context of BigO, which offers an interactive data platform for the exploration of objective obesity-related behaviors and local environments based on the data recorded using the BigO mHealth (mobile health) app. METHODS: The OPdashboard, which can be accessed on the web, allows for (1) the real-time monitoring of children's obesogenic behaviors in a city area, (2) the extraction of associations between these behaviors and the local environment, and (3) the evaluation of interventions over time. More than 3700 children from 33 schools and 2 clinics in 5 European cities have been monitored using a custom-made mobile app created to extract behavioral patterns by capturing accelerometer and geolocation data. Online databases were assessed in order to obtain a description of the environment. The dashboard's functionality was evaluated during a focus group discussion with public health experts. RESULTS: The preliminary association outcomes in 2 European cities, namely Thessaloniki, Greece, and Stockholm, Sweden, indicated a correlation between children's eating and physical activity behaviors and the availability of food-related places or sports facilities close to schools. In addition, the OPdashboard was used to assess changes to children's physical activity levels as a result of the health policies implemented to decelerate the COVID-19 outbreak. The preliminary outcomes of the analysis revealed that in urban areas the decrease in physical activity was statistically significant, while a slight increase was observed in the suburbs. These findings indicate the importance of the availability of open spaces for behavioral change in children. Discussions with public health experts outlined the dashboard's potential to aid in a better understanding of the interplay between children's obesogenic behaviors and the environment, and improvements were suggested. CONCLUSIONS: Our analyses serve as an initial investigation using the OPdashboard. Additional factors must be incorporated in order to optimize its use and obtain a clearer understanding of the results. The unique big data that are available through the OPdashboard can lead to the implementation of models that are able to predict population behavior. The OPdashboard can be considered as a tool that will increase our understanding of the underlying factors in childhood obesity and inform the design of regional interventions both for prevention and treatment.

Fast Eating Is Associated with Increased BMI among High-School Students.

Fast self-reported eating rate (SRER) has been associated with increased adiposity in children and adults. No studies have been conducted among high-school students, and SRER has not been validated vs. objective eating rate (OBER) in such populations. The objectives were to investigate (among high-school student populations) the association between OBER and BMI z-scores (BMIz), the validity of SRER vs. OBER, and potential differences in BMIz between SRER categories. Three studies were conducted. Study 1 included 116 Swedish students (mean ± SD age: 16.5 ± 0.8, 59% females) who were eating school lunch. Food intake and meal duration were objectively recorded, and OBER was calculated. Additionally, students provided SRER. Study 2 included students (n = 50, mean ± SD age: 16.7 ± 0.6, 58% females) from Study 1 who ate another objectively recorded school lunch. Study 3 included 1832 high-school students (mean ± SD age: 15.8 ± 0.9, 51% females) from Sweden (n = 748) and Greece (n = 1084) who provided SRER. In Study 1, students with BMIz ≥ 0 had faster OBER vs. students with BMIz < 0 (mean difference: +7.7 g/min or +27%, p = 0.012), while students with fast SRER had higher OBER vs. students with slow SRER (mean difference: +13.7 g/min or +56%, p = 0.001). However, there was "minimal" agreement between SRER and OBER categories (κ = 0.31, p < 0.001). In Study 2, OBER during lunch 1 had a "large" correlation with OBER during lunch 2 (r = 0.75, p < 0.001). In Study 3, fast SRER students had higher BMIz vs. slow SRER students (mean difference: 0.37, p < 0.001). Similar observations were found among both Swedish and Greek students. For the first time in high-school students, we confirm the association between fast eating and increased adiposity. Our validation analysis suggests that SRER could be used as a proxy for OBER in studies with large sample sizes on a group level. With smaller samples, OBER should be used instead. To assess eating rate on an individual level, OBER can be used while SRER should be avoided.

Collecting big behavioral data for measuring behavior against obesity.

Obesity is currently affecting very large portions of the global population. Effective prevention and treatment starts at the early age and requires objective knowledge of population-level behavior on the region/neighborhood scale. To this end, we present a system for extracting and collecting behavioral information on the individual-level objectively and automatically. The behavioral information is related to physical activity, types of visited places, and transportation mode used between them. The system employs indicator-extraction algorithms from the literature which we evaluate on publicly available datasets. The system has been developed and integrated in the context of the EU-funded BigO project that aims at preventing obesity in young populations.

BigO: A public health decision support system for measuring obesogenic behaviors of children in relation to their local environment.

Obesity is a complex disease and its prevalence depends on multiple factors related to the local socioeconomic, cultural and urban context of individuals. Many obesity prevention strategies and policies, however, are horizontal measures that do not depend on context-specific evidence. In this paper we present an overview of BigO (http://bigoprogram.eu), a system designed to collect objective behavioral data from children and adolescent populations as well as their environment in order to support public health authorities in formulating effective, context-specific policies and interventions addressing childhood obesity. We present an overview of the data acquisition, indicator extraction, data exploration and analysis components of the BigO system, as well as an account of its preliminary pilot application in 33 schools and 2 clinics in four European countries, involving over 4,200 participants.

Inferring the Spatial Distribution of Physical Activity in Children Population from Characteristics of the Environment.

Obesity affects a rising percentage of the children and adolescent population, contributing to decreased quality of life and increased risk for comorbidities. Although the major causes of obesity are known, the obesogenic behaviors manifest as a result of complex interactions of the individual with the living environment. For this reason, addressing childhood obesity remains a challenging problem for public health authorities. The BigO project (https://bigoprogram.eu) relies on large-scale behavioral and environmental data collection to create tools that support policy making and intervention design. In this work, we propose a novel analysis approach for modeling the expected population behavior as a function of the local environment. We experimentally evaluate this approach in predicting the expected physical activity level in small geographic regions using urban environment characteristics. Experiments on data collected from 156 children and adolescents verify the potential of the proposed approach. Specifically, we train models that predict the physical activity level in a region, achieving 81% leave-one-out accuracy. In addition, we exploit the model predictions to automatically visualize heatmaps of the expected population behavior in areas of interest, from which we draw useful insights. Overall, the predictive models and the automatic heatmaps are promising tools in gaining direct perception for the spatial distribution of the population's behavior, with potential uses by public health authorities.

Behaviour Profiles for Evidence-based Policies Against Obesity.

Obesity is a preventable disease that affects the health of a significant population percentage, reduces the life expectancy and encumbers the health care systems. The obesity epidemic is not caused by isolated factors, but it is the result of multiple behavioural patterns and complex interactions with the living environment. Therefore, in-depth understanding of the population behaviour is essential in order to create successful policies against obesity prevalence. To this end, the BigO system facilitates the collection, processing and modelling of behavioural data at population level to provide evidence for effective policy and interventions design. In this paper, we introduce the behaviour profiles mechanism of BigO that produces comprehensive models for the behavioural patterns of individuals, while maintaining high levels of privacy protection. We give examples for the proposed mechanism from real world data and we discuss usages for supporting various types of evidence-based policy design.

Personalised meal eating behaviour analysis via semi-supervised learning.

Automated monitoring and analysis of eating behaviour patterns, i.e., "how one eats", has recently received much attention by the research community, owing to the association of eating patterns with health-related problems and especially obesity and its comorbidities. In this work, we introduce an improved method for meal micro-structure analysis. Stepping on a previous methodology of ours that combines feature extraction, SVM micro-movement classification and LSTM sequence modelling, we propose a method to adapt a pretrained IMU-based food intake cycle detection model to a new subject, with the purpose of improving model performance for that subject. We split model training into two stages. First, the model is trained using standard supervised learning techniques. Then, an adaptation step is performed, where the model is fine-tuned on unlabeled samples of the target subject via semisupervised learning. Evaluation is performed on a publicly available dataset that was originally created and used in [1] and has been extended here to demonstrate the effect of the semisupervised approach, where the proposed method improves over the baseline method.

CAROTID - a web-based platform for optimal personalized management of atherosclerotic patients.

Carotid atherosclerosis is the main cause of fatal cerebral ischemic events, thereby posing a major burden for public health and state economies. We propose a web-based platform named CAROTID to address the need for optimal management of patients with carotid atherosclerosis in a twofold sense: (a) objective selection of patients who need carotid-revascularization (i.e., high-risk patients), using a multifaceted description of the disease consisting of ultrasound imaging, biochemical and clinical markers, and (b) effective storage and retrieval of patient data to facilitate frequent follow-ups and direct comparisons with related cases. These two services are achieved by two interconnected modules, namely the computer-aided diagnosis (CAD) tool and the intelligent archival system, in a unified, remotely accessible system. We present the design of the platform and we describe three main usage scenarios to demonstrate the CAROTID utilization in clinical practice. Additionally, the platform was evaluated in a real clinical environment in terms of CAD performance, end-user satisfaction and time spent on different functionalities. CAROTID classification of high- and low-risk cases was 87%; the corresponding stenosis-degree-based classification would have been 61%. Questionnaire-based user satisfaction showed encouraging results in terms of ease-of-use, clinical usefulness and patient data protection. Times for different CAROTID functionalities were generally short; as an example, the time spent for generating the diagnostic decision was 5min in case of 4-s ultrasound video. Large datasets and future evaluation sessions in multiple medical institutions are still necessary to reveal with confidence the full potential of the platform.